Alexian Brothers Medical Center (ABMC), a 400-bed community hospital in Elk Grove Village, Illinois, runs a 24/7-pharmacy operation. However, during the midnight shift—12:00am to 6:00am, seven days a week—we have only one pharmacist working. As the acuity of patients treated during this shift began to grow over the last few years, the increasing complexity of care necessitated more physician order activity. With the upsurge in medication orders, it became evident that midnight staff would require help in order to continue safely and efficiently serving our patients. While options such as hiring additional pharmacists or overlapping evening and morning shifts to help balance the orders were presented, we felt such actions would be either too costly or would decrease employee satisfaction.
Flexibility is Key
In the fall of 2008, I attended a hospital pharmacy conference where I met a representative from Pipeline Healthcare Solutions, a telepharmacy company that offers remote order entry services provided by licensed, clinical hospital pharmacists. Although we had not previously considered telepharmacy as an option for alleviating the increasing workload, the idea of having an experienced and dedicated pharmacist team that could help process medication orders appeared both financially viable and safely accountable.
What appealed to us about their flexible services was the ability to develop a custom solution that would provide a support coverage window of just four hours during our midnight shifts; the period of increased workload. To initiate the program, a representative visited ABMC to assess our needs and review our existing technology. Their subsequent proposal demonstrated seamless service integration with ABMC pharmacy workflow (by means of a secure network connection) that would follow our own policies and procedures and comply with established formulary drug sets. In addition to processing orders remotely, the pharmacists would be able to make appropriate clinical interventions and communicate with our physicians and nurses as needed. Proposed cost savings data was included in the proposal to our chief operating officer and ultimately the telepharmacy initiative was approved and then implemented in February 2010.
Cost and Operational Benefits
Central to the success of this service is Pipeline’s ability to manage our enhanced workload in a cost effective manner, thus freeing our on-site pharmacist to attend to clinical functions. What truly enabled this was having our dedicated Pipeline pharmacists come on-site to train with our in-house staff and become familiar with the hospital’s processes, policies, and expectations. Moreover, we were given a copy of the client operations policy and procedure manual, which includes the information our facility would need to supply during a Joint Commission survey to ensure we meet all regulatory guidelines. Additionally, we are provided with a weekly and monthly report that tracks the number of medication orders entered by Pipeline staff, clinical interventions documented, and any administrative actions, as well as the number of phone calls made daily to the service. These reports allow us to closely monitor the breadth and quality of remote order entry activity.
Currently we use the telepharmacy services from 2:00am to 6:00am, seven days a week during the critical time when order queue and phone call volume increase in the pharmacy. The orders are triaged by the pharmacist and any routine orders or medication reconciliation orders are faxed to Pipeline for their pharmacist to process. This pharmacist can access our computer system and enter orders, as well as any interventions completed as a result of order entry into our web-based intervention system. Additionally, if the remote pharmacist has any questions about the medication orders, they directly call the appropriate nursing unit at ABMC to resolve the issue.
Ensuring Peace of Mind
Pipeline’s flexible business model and stable of experienced pharmacists were significant factors in our decision to employ remote order entry to mitigate our increased workload on the midnight shift. Their expertise, technology, and personalized service have served as a direct extension of our on-site pharmacy services. Furthermore, our employees are confident in the assistance of our Pipeline team and our nurses are likewise pleased with the speedier order turnaround time. Thus far, our remote pharmacists average 94 documented interventions per month. This translates to $5,640 of soft savings per month, or $67,680 soft savings per year. In addition to these savings, since implementing telepharmacy services, we no longer start the day behind, as the night orders are all processed in a timely manner due to a sustained 26% decrease in turnaround time for routine orders on the midnight shift.
Joan Hardman, RPh, is the director of pharmacy services at Alexian Brothers Medical Center in Elk Grove Village, Illinois. Joan received her BS in pharmacy from the University of Illinois Chicago and currently serves on the quality board of Roosevelt University’s school of pharmacy.